Personal Statement Form

Transcription

1 A SEPARATE FORM MUST BE COMPLETED FOR EACH PARTNER, DIRECTOR, COMPANY SECRETARY AND DESIGNATED MEMBER LISTED AT SECTION 5 WITHIN THE APPLICATION FORM Please enter business name above Please enter your name above Please complete this personal statement form as fully as possible. Any parts not fully completed or omitted may result in your application being deferred or rejected. The East of Scotland Investment Fund has been part financed by the European Regional Development Fund (ERDF) through the Lowlands and Uplands Scotland (European Structural Funds) Programmes.

2 Data Protection Act 1998 The information you provide in this form will be processed by the East of Scotland Investment Fund Ltd (ESIF) or by one of its member authorities. ESIF is the data controller for the purposes of the Data Protection Act 1998 in order to process your application for loan funding. ESIF is under an obligation to manage public funds properly and accordingly the information will be used to prevent and detect fraud and may be shared for the same purposes with other public bodies including for example, but not exhaustive: local authorities, Scottish Enterprise, Business Gateway, Scottish Government, ESEP Ltd, HMRC, HM Constabulary etc. Business Credit Checks All businesses applying for loan funding will be assessed for credit worthiness. The credit check will involve the disclosure of information to ESIF and its member authorities including: Any credit reference: for example, but not exhaustive: Experian, Equifax, Dun & Bradstreet, for the purpose of ascertaining the credit worthiness of the business and the related owner, partners, directors, company secretary and designated members etc. Other information, for example but not exhaustive, Companies House records which exist in the public domain (annual accounts, annual returns, disqualified directors register etc.) The Finance Department of the Council for the purposes of ascertaining the existence or otherwise of rent, rates and council tax arrears Personal Credit Checks All individuals (partners, directors, company secretary, designated members) are required to submit their own personal credit check. This information will be used to help appraise your application for loan funding. A copy of your statutory credit report is available from Experian: The report costs 2.00 and will give ESIF a clear understanding of your personal credit worthiness and financial status. You may wish to provide your personal credit report using an alternative provider. 2

3 1. Personal Information Full name (including middle names) Previous names Home address (including flat position) Town Postcode Home phone number Mobile phone number If you have lived at the above address for less than three years please state your previous address Town Postcode Date of birth National Insurance number Marital status Number of dependents Your home Owner Mortgaged Tenant Living with parents If you have or had any other business interests please list below details of those business interests where you own or owned 5% or more of the business Business Name Legal Status (Sole Trader, Partnership, Limited Company, Limited Liability Partnership) Position Still Trading Yes No 3

4 2. Personal Banking Information Bank name Branch name Branch address Town Postcode Account name Account number Sort code Length of time at this bank? 3. Anti-Money Laundering Legislation In order to comply with Anti-money laundering legislation you are required to provide evidence to confirm your identity and address. Confirmation of Identity - any 1 from the following (Please tick) Current passport Current UK photocard driving licence NHS medical card Confirmation of Address - any 1 from the following (Please tick) Recent utility bill (within last 3 months) (mobile phone or internet access bill is not acceptable) Bank or credit card statements (within last 3 months) Mortgage statement (within last 3 months) 4

5 4. Declaration and Signature for each Partner, Director, Company Secretary or Designated Member Please read the following statements carefully and tick the yes or no boxes accordingly. Yes No 1 Have you ever been sequestrated, declared bankrupt, or been subject to an arrangement with creditors? 2 Have you ever signed a Protected Trust Deed? 3 Have you at any time been disqualified from being a company director under the Company Directors Disqualification Act (1986)? 4 Have you at any time been the owner, partner or director of a business subject to investigation under the Companies, Financial Services or Banking Acts? 5 Have you ever been found guilty of a criminal offence? 6 Have you ever been investigated by the Her Majesty s Revenue & Customs (HMRC) or the Serious Fraud Office? 7 Have you had an alias or at any time changed your name? 8 Have you at any time been a director, company secretary, partner or owner of a business that has been subject to formal insolvency procedures such as Receivership, Liquidation or Administration? 9 Has any business of which you have been an Owner, Partner, Director, Company Secretary or Designated Member committed a criminal offence? 10 Has your auditor / accountant ever qualified the accounts of any business while you were an Owner, Partner, Director, Company Secretary or Designated Member? If you have answered Yes to any of the statements above please give details in the box below 11 Are you aware of what money laundering is and of the duty to report such activity? 12 Are you aware of when a company is insolvent and that wrongful trading and unfair preference in such a situation is an offence? Please read the following statements carefully and tick to indicate that you have read and understood each point before signing this form: I hereby consent to you obtaining any relevant personal or company data from for example, but not exhaustive, Experian, Equifax, Dun & Bradstreet for the purpose of ascertaining the credit worthiness of nyself and the business. Other information, for example but not exhaustive, Companies House, for the purpose of obtaining accounts, annual returns etc. The Finance Department of the Council for the purpose of ascertaining the existence, or otherwise, or rent, rates or council tax arrears. I authorise that the information provided above can be shared between ESIF, local authorities, Scottish Enterprise, Business Gateway, Scottish Government, ESEP Ltd, HMRC, HM Constabulary and any other lenders, investors or proposed lenders or investors in the company. I acknowledge ESIF has been part financed by the European Regional Development Fund (ERDF) through the Lowlands and Uplands Scotland (European Structural Funds) Programmes. As a recipient of ERDF funding and on behalf of my business I accept the obligation to co-operate fully in the event of an audit and will make such information available as auditors require before, during and after the audit throughout the auditable life of the Fund. 5

6 The information I have provided in this application and any supporting documentation is, as far as I believe, accurate and complete. I accept that any offer of loan funding will be based on the information provided. I accept that we will have to immediately pay back all or part of any loan funding we receive if any information in this application or any supporting document is found to be incorrect, or if we do not meet the conditions under which the loan funding is offered. I accept we agree to maintain proper business insurance cover e.g. Employer s Liability Insurance, Public Liability Insurance. I accept we agree to continually comply with all current UK and European laws including the Equality Act 2010 and the Health and Safety Act I agree to comply with the National Minimum Wage legislation. I agree that you may consult any other person, bank or company named in this application. I shall provide you with up to date financial information including management accounts and audited or certified annual accounts. I accept that your decision on whether or not to offer loan funding is final and we cannot appeal against it. What will happen to this Form? If your application is unsuccessful, this form will be destroyed at the time of refusal. If your application for loan funding is successful, this form along with any personal credit report, submitted with your application, will be retained by the respective local authority for the duration of the ERDF programme, thereafter it will be destroyed. By returning this form to us duly completed you consent to us processing relevant sensitive data about you where this is necessary. When you have completed the Personal Statement Form please sign it below and return it with the Application Form along with all other Personal Statement Forms to the nominated person for your local authority, identified at Section 8, Contact Details within the Application Form. Your signature Name (please print): Position in Business: Date: The East of Scotland Investment Fund has been part financed by the European Regional Development Fund (ERDF) through the Lowlands and Uplands Scotland (European Structural Funds) Programmes. 6